Does bariatric surgery slow kidney disease progression?

Question

Hi doctor,

My father is 59 years old and has had type 2 diabetes for many years. He was just diagnosed with chronic renal disease stage 2. He is also rather overweight at 5 feet 9 inches and weighs about 325 pounds.

Unfortunately, his general health appears to be deteriorating. He takes a lot of drugs, but his blood glucose levels remain stubbornly high, and his nephrologist is concerned about his kidney function, based on recent test findings.

Regarding his weight difficulties, we are considering metabolic (bariatric) surgery as it seems to be one of the last alternatives available to help with his diabetes. His primary care doctor said it could bring considerable benefits, but having kidney illness complicates the decision.

We are concerned about the possible surgical risks with his present kidney function. He is often tired and becomes short of breath with little physical exercise.

Generally speaking, is metabolic surgery safe for a case like his, for someone with stage 2 kidney disease?
Is there evidence, too, that it might reduce the progression of renal disease or preserve kidney function over the long term?

Thank you for your time and advice.

Would really appreciate any recommendations you have.

Answer 1

Hi,

Welcome to icliniq.com

I hope you are doing well.

Your desire to look at all of your choices is understandable, and you are asking important questions about the pros and cons of metabolic surgery in light of your father’s health problems.

In many cases, metabolic (bariatric) surgery can be performed safely in patients with early-stage chronic kidney disease (CKD stages 1 to 3), provided they undergo a thorough medical evaluation and receive care from an experienced multidisciplinary team.

If your father’s renal illness is in its early stages, there is often enough kidney function to withstand surgery if proper safeguards are taken. However, in view of his diabetes, obesity, shortness of breath, and decreasing health state, a detailed preoperative assessment is mandatory.

This evaluation typically includes:

Cardiology clearance, particularly because of his fatigue and shortness of breath.
Pulmonary evaluation if conditions such as sleep apnea are suspected.
Close involvement of a nephrologist to help protect kidney function before, during, and after surgery.
Coordination among the bariatric surgeon, endocrinologist, anesthesiologist, and other specialists involved in his care.

So, kidney disease is not a reason to totally avoid surgery. People with kidney disease need to be very careful and plan things out.

Metabolic surgery has been demonstrated in studies to delay the progression of kidney disease and, in some cases, stabilize renal function, helping to retain kidney function. These benefits are generally associated with improvement in several critical criteria, such as:

Better blood sugar control.
Lower blood pressure.
Sustained weight loss.
Less inflammation and metabolic stress.
Less strain on the kidneys.

Many patients have a significant improvement in diabetes control after surgery. Some studies show stabilization or improvement of kidney function measurements over time.

Because of your father's BMI and kidney issues, he is at a higher risk of dehydration, blood clots, and infection. Careful fluid and electrolyte monitoring after surgery and a preoperative heart assessment are also important.

These are real hazards, but with proper planning, good surgical care, and diligent follow-up in the post-operative period, they are generally manageable with good results.

Sleeve gastrectomy is often regarded as a good choice for patients with kidney-related problems because it is usually a less extensive and technically easier procedure than gastric bypass. It is less likely to cause malabsorption of nutrients.

That said, the best management plan can only be decided after a complete medical assessment and discussion with the surgical team.

Good luck.